Yu Yongchun, Sun Jie, Lai Wenli, Wu Taixiang, Koshy Stephen, Shi Zongdao
Department of Orthodontics, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China, 610041.
Cochrane Database Syst Rev. 2013 Sep 6;2013(9):CD008734. doi: 10.1002/14651858.CD008734.pub2.
Orthodontic relapse can be defined as the tendency for teeth to return to their pre-treatment position, and this occurs especially in lower front teeth (lower canines and lower incisors). Retention, to maintain the position of corrected teeth, has become one of the most important phases of orthodontic treatment. However, 10 years after the completion of orthodontic treatment, only 30% to 50% of orthodontic patients effectively retain the satisfactory alignment initially obtained. After 20 years, satisfactory alignment reduces to 10%. When relapse occurs, simple effective strategies are required to effectively manage the problem. The periodontal, physiological or psychological conditions may be different from those before orthodontic treatment, so re-treatment methods may also need to be different.
To assess the effects of interventions used to manage relapse of the lower front teeth after first fixed orthodontic treatment.
The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 9 November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE via OVID (1950 to 9 November 2012), EMBASE via OVID (1980 to 9 November 2012). There were no restrictions regarding language or date of publication. A thorough handsearch was done in relation to the following journals: American Journal of Orthodontics and Dentofacial Orthopedics (1970 to 9 November 2012), Angle Orthodontist (1978 to 9 November 2012), European Journal of Orthodontics (1979 to 9 November 2012), Journal of Orthodontics (1978 to 9 November 2012), Chinese Journal of Stomatology (1953 to 9 November 2012), West China Journal of Stomatology (1983 to 9 November 2012), Chinese Journal of Dental Materials and Devices (1992 to 9 November 2012) and Chinese Journal of Orthodontics (1994 to 9 November 2012).
We would have included randomised controlled trials (RCTs) which compared any of the following: fixed options (including labial braces, lingual braces and fixed lingual wire), removable options (including Hawley's retainer with active components such as Hawley's retainer with spring elastomeric module, Bloore removable aligner and any other modifications on the Hawley's retainer to correct the lower front teeth, and invisible removable aligners such as Invisalign and Clearstep) and no active treatment for the management of relapsed lower front teeth after orthodontic treatment. We excluded RCTs of participants with craniofacial deformities/syndromes or serious skeletal deformities who received prior surgical/surgical orthodontic treatment.
Two review authors, independently and in duplicate, assessed the results of the searches to identify studies for inclusion. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.
We did not identify any RCTs which met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS: This review has revealed that there was no evidence from RCTs to show that one intervention was superior to another to manage the relapse of the alignment of lower front teeth using any method or index, aesthetic assessment by participants and practitioners, treatment time, patient's discomfort, quality of life, cost-benefit considerations, stability of the correction, and side effects including pain, gingivitis, enamel decalcification and root resorption. There is an urgent need for RCTs in this area to identify the most effective and safe method for managing the relapse of alignment of the lower front teeth.
正畸复发可定义为牙齿回到治疗前位置的倾向，尤其发生在下前牙（下尖牙和下切牙）。保持矫治后牙齿的位置已成为正畸治疗最重要的阶段之一。然而，正畸治疗完成10年后，只有30%至50%的正畸患者能有效保持最初获得的满意牙列排列。20年后，满意的牙列排列降至10%。当复发发生时，需要简单有效的策略来有效解决该问题。牙周、生理或心理状况可能与正畸治疗前不同，因此再治疗方法可能也需要有所不同。
评估用于处理首次固定正畸治疗后下前牙复发的干预措施的效果。
检索了以下电子数据库：Cochrane口腔健康组试验注册库（至2012年11月9日）、Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2012年第10期）、通过OVID检索的MEDLINE（1950年至2012年11月9日）、通过OVID检索的EMBASE（1980年至2012年11月9日）。对语言或出版日期无限制。对以下期刊进行了全面的手工检索：《美国正畸与牙颌面正畸杂志》（1970年至2012年11月9日）、《安氏正畸医师》（1978年至2012年11月9日）、《欧洲正畸杂志》（1979年至2012年11月9日）、《正畸杂志》（1978年至2012年11月9日）、《中华口腔医学杂志》（1953年至2012年11月9日）、《华西口腔医学杂志》（1983年至2012年11月9日）、《口腔材料器械杂志》（1992年至2012年11月9日）和《中华正畸学杂志》（1994年至2012年11月9日）。
我们纳入了比较以下任何一种情况的随机对照试验（RCT）：固定矫治器选项（包括唇侧矫治器、舌侧矫治器和固定舌弓丝）、可摘矫治器选项（包括带有弹簧弹性模块等活动部件的Hawley保持器、Bloore可摘矫治器以及对Hawley保持器进行的任何其他用于矫正下前牙的改良，以及Invisalign和Clearstep等隐形可摘矫治器）与正畸治疗后复发的下前牙不进行积极治疗。我们排除了患有颅面畸形/综合征或严重骨骼畸形且之前接受过手术/外科正畸治疗的参与者的RCT。
两位综述作者独立且重复地评估检索结果，以确定纳入的研究。数据合成将遵循Cochrane协作网统计指南。
我们未识别出任何符合本综述纳入标准的RCT。
本综述表明，从RCT中没有证据显示使用任何方法或指标（包括参与者和从业者的美学评估、治疗时间、患者不适、生活质量、成本效益考量、矫治稳定性以及包括疼痛、牙龈炎、牙釉质脱矿和牙根吸收在内的副作用）处理下前牙排列复发时，一种干预措施优于另一种。该领域迫切需要RCT来确定处理下前牙排列复发最有效和安全的方法。
